Manipulative techniques have been used by many cultures throughout history. Osteopaths can use low or high velocity thrusts in a larger or smaller amplitude, meaning the manoeuvre is slow or fast and occurs over a longer or shorter distance within the joint movement. The choice depends on the assessment and the clinical judgement of the osteopath.


In osteopathy, counterstrain is an idea and a treatment technique used to manage “dysfunction”, which refers to tightness, weakness and imbalance in the tissues of the body.

Counterstrain uses a system of diagnosis and treatment based on tender points occurring in the soft tissues, perhaps similar to “trigger point” therapy used by some manual therapists. Tender points are thought to occur due to an inappropriate muscle spasm reflex caused by poorly functioning muscle groups.

Lawrence Jones developed the idea around 1955 and called it “spontaneous release by positioning”. Since then it has also be called strain-counterstrain, Jones technique and spontaneous release by position.

Tender points are small, specific and mildly swollen areas in body tissues that are painful when pressed firmly as by a therapist. The osteopath then positions the patient’s trunk or limbs so that the counterstrain point shows its minimum tenderness, a position of ease.

Holding the body in that posture for around 90 seconds, the osteopath then returns the person to the neutral posture and checks for the point tenderness and changes in joint range.

In examining muscles and joints, practitioners of this technique have identified over 200 tender points in joints and muscles. Various other manipulative techniques may also be applied in treating this presentation.

Muscle Energy Techniques

Muscle energy techniques (METs) include a number of therapies used by osteopaths and other manual therapists. They aim to improve the function of joints and muscles and to reduce pain. They are an “active” treatment, in that the patient is asked to work their muscles and joints in the process.

First described by Fred Mitchell, an osteopath, in 1948, METs ask a patient to resist the therapist in a very specific direction and in a very specific position. The aim is to reduce muscle spasm, improve pain and increase joint ranges of movement.

Muscle energy techniques are mostly used to deal with:

  • Limited joint movement due to increased or decreased muscle tone. Overuse of a muscle can cause a continual low-level spasm, reducing its flexibility and causing the muscle to ache.
  • When one set of muscles is involved (the agonists), the opposing set (the antagonists) can also become involved, leading again to pain and loss of movement.

By making a person’s muscles contract strongly in a static position, muscles are inhibited and, on relaxation again, the joint movement may be seen to increase.

There are only a few studies showing evidence for muscle energy techniques, so scientific validation of this technique in unclear. They may be used to help back pain, short and tight muscle groups, limited joint movement and headaches from the neck.

Craniosacral Osteopathy

Some osteopaths specialise exclusively in this alternative therapy. Craniosacral therapists palpate the joints of the skull and claim to be able to release energy or fluid blockages, leading to improvements in symptoms.

These techniques were initially used to treat the head but are now used throughout the body.

The underlying idea is that there are small, regular movements of the skull bones, which are suggested are due to changes in fluid pressures in the brain. Practitioners claim they can feel these small movements and manipulate the cranial bones to give an effective treatment.

The evidence for the effectiveness of craniosacral therapies is not clear.

Myofascial Release

Robert Ward, an osteopath, initially named this technique in 1960 and it consists of a low pressure manual force being applied for a long duration to fascia and muscles. It is used for various disorders including the temporomandibular joint (TMJ), tension headaches and joint pains.

Lymphatic Manipulative Techniques

These techniques, related to massage, have been part of therapeutic practice for many years. Some are used for treatment of lymphoedema.

Techniques vary from looking for and unblocking points of resistance to lymph flow, massaging superficial lymph to enhance flow and stimulating lymph passage through pumping actions of muscles and joints.